Right Heart Thrombus in Transit Diagnosed by Bedside Ultrasound

Martires, Joanne; Stein, Susan J.; Kamangar, Nader

doi:10.1016/j.jemermed.2014.11.011

Cited by 7 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, specific thrombolytic therapy-related complications were reported in only six patients and included intracranial hematoma, epistaxis, mild hematuria, circulatory collapse, allergic reaction to urokinase, and unspecified sudden death. 56–60 A retrospective study on right heart thrombi and PE from Turkey reported major bleeding after thrombolytic therapy in 18% of patients, similar to bleeding trends seen in PE from other causes. 61 Our review found a median hospital stay of 9.5 days in patients with FFRHT in the context of PE which seems longer than that of PE in general (6 days).…”

Section: Discussionmentioning

confidence: 76%

Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis

Ibrahim

Ata

Choudry

et al. 2022

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We performed a systematic review and meta-analysis addressing prevalence, clinical behavior, and outcomes of FFRHT associated with PE. Among the included 397 patients with FFRHT and PE, dyspnea was the main presenting symptom (73.3%). Obstructive shock was documented in 48.9% of cases. Treatment with thrombolytic therapy, surgical thrombectomy, and percutaneous thrombectomy was documented in 43.8%, 32.7%, and 6.5% of patients, respectively. The overall mortality rate was 20.4%. Syncope ( p: 0.027), chest pain ( p: 0.006), and obstructive shock ( p: 0.037) were significantly associated with mortality. Use of thrombolytic therapy was significantly associated with survival ( p: 0.008). A multivariate logistic regression model to determine mortality predictors revealed that syncope (OR: 1.97, 95% CI: 1.06–3.65, p: 0.03), and obstructive shock (OR: 2.23, 95% CI: 1.20–4.14, p: 0.01) were associated with increased death odds. Treatment with thrombolytic therapy (OR: 0.22, 95% CI: 0.086–0.57, p: 0.002) or surgical thrombectomy (OR: 0.35, 95% CI: 0.137–0.9, p: 0.03) were associated with reduced death odds. Meta-analysis of observational studies revealed a pooled prevalence of FFRHT among all PE cases of 8.1%, and overall mortality of 23%. Although uncommon, the presence of FFRHT in the context of PE is associated with high obstructive shock and mortality rates. Favorable survival odds are observed with thrombolytic therapy and surgical thrombectomy. Data are derived from case reports and observational studies. Clinical trials elucidating these findings are needed.

show abstract

Section: Discussionmentioning

confidence: 76%

Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis

Ibrahim

Ata

Choudry

et al. 2022

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…The moderator band, papillary muscle, and coarse trabeculations in RV make the diagnosis of right ventricular thrombus challenging ( 5 ). A thrombus in the right heart usually originates from deep vein thrombosis, and other common causes include atrial fibrillation and intracardiac foreign bodies, such as prosthetic valves, pacemakers, and catheters ( 6 , 7 ). Besides, some rare causes of RVT formation have been reported in hypercoagulable states (factor V deficiency, protein C and protein S deficiencies), Bechet's disease, antiphospholipid syndrome (APLAS), eosinophilia, primary thrombocytopenia, RV infarction, and various cardiomyopathies such as dilated or alcoholic cardiomyopathy and arrhythmogenic right ventricular dysplasia ( 8 – 10 ), but RVT was less frequently described in myocarditis.…”

Section: Discussionmentioning

confidence: 99%

Myocarditis complicated by massive right ventricular thrombus and extensive pulmonary embolism: A case report

Jiang

Zhang²

2022

Front. Surg.

View full text Add to dashboard Cite

An intracardiac thrombus may develop as a consequence of myocarditis, and in rare cases, a dominantly right ventricular thrombus develops, which may impair cardiac function and even cause life-threatening cardiovascular events. We report a 24-year-old man presented with recurrent episodes of palpitation and precordial discomfort after catching a cold 2 months ago. Transthoracic echocardiography (TTE) and computed tomography pulmonary angiogram (CTPA) revealed a mass attached to the apex of the right ventricle and extensive bilateral pulmonary artery emboli. There was no indication where the thrombi originated from in this young patient without any underlying disease except myocarditis. Pulmonary endarterectomy and embolectomy of pulmonary arteries and right ventricle were performed. Postoperative pathological results confirmed the presence of fibrinous necrosis and hemosiderin deposition. The formation of an intraventricular thrombus is closely related to myocarditis, which can affect individuals of all ages, but especially young people. Thus, patients with myocarditis should be closely monitored and followed up because of the increased risk of extensive thrombosis.

show abstract

“…RHTT is uncommon and management decisions are often based on risk stratification and center expertise, as there are currently no randomized control trials comparing treatment options. Nonetheless, studies suggest anticoagulation therapy is insufficient on its own, particularly when high-risk features including large size and extent of the in-transit clot (free floating), as well as submassive PE, are present [5,12]. Others have suggested no mortality benefit with thrombolysis [4].…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit

Mardinger

Boiteau

Kortbeek

2020

Case Reports in Medicine

View full text Add to dashboard Cite

Right heart thrombus in transit clot (RHTT) associated with a pulmonary thromboembolism (PTE) is a rare but potentially fatal diagnosis. Early diagnosis and immediate intervention are crucial. This report describes the case of a healthy, physically active 32-year-old female who presented 19 days postoperatively, following an anterior cruciate ligament reconstruction and partial lateral meniscectomy with a saddle PE, RHTT, and right ventricular (RV) strain. The patient received half of the standard dose of intravenous tissue plasminogen activator (TPA) in combination with anticoagulation and survived. Case reports of RHTT will inform future studies designed to evaluate whether and when thrombolysis should be administered.

show abstract

Right Heart Thrombus in Transit Diagnosed by Bedside Ultrasound

Cited by 7 publications

References 11 publications

Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis

Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis

Myocarditis complicated by massive right ventricular thrombus and extensive pulmonary embolism: A case report

Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit

Contact Info

Product

Resources

About